Association between Graves' disease and risk of incident systemic lupus erythematosus: A nationwide population‐based cohort study

Abstract

Objective Previous case reports have linked Graves' disease to incident systemic lupus erythematosus (SLE). It has also been reported that antithyroid drugs used to treat Graves' disease can induce SLE development. The purpose of this study was to investigate the risk of SLE in patients with Graves' disease. Methods A total of 8779 patients with Graves' disease and 8779 controls (without Graves' disease) matched by age, gender, index year, and Charlson Comorbidity Index (CCI) score were enrolled between 2000‐2012. Patients were then followed until the end of 2013 using Taiwan's National Health Insurance Research Database, at which time participants who developed SLE were identified. Cox regression analysis was used to calculate the hazard ratio (HR) with a 95% confidence interval (CI) of SLE incidence rate between patients with Graves' disease and unaffected controls. Results Patients with Graves' disease had a significantly increased risk of SLE than unaffected controls (8.81 vs 2.83 per 10 000 person‐years, HR: 5.45, 95% CI: 1.74‐17.0) after adjusting for antithyroid therapies (antithyroid drugs, radioactive iodine ablation, and surgery). Diagnostic bias may be present as patients with Graves' disease may seek more help from healthcare providers. After excluding the first 0.5 and 1 year of observation period, similar results were obtained (excluding 0.5 year ‐ HR: 4.30, 95% CI: 2.78‐8.57; excluding 1 year ‐ HR: 4.63, 95% CI: 2.33‐7.79). Conclusion This study shows that Graves' disease is associated with an increased risk of incident SLE. Further studies on the underlying pathogenesis linking Graves' disease and SLE are warranted.

The potential causal association between systemic lupus erythematosus and endocrine and metabolic disorders in the East Asian population: A bidirectional two-sample Mendelian randomization study

“…20 SLE and GD frequently cooccur, with elevated incidence for both GD among SLE individuals and subsequent SLE development in GD patients. [21][22][23] This study confirmed a significant correlation between genetic variations strongly associated with SLE in the East Asian population and an elevated risk of GD occurrence through univariable MR analysis (OR 1.12). In other words, SLE patients in the East Asian population have a 12% higher risk of developing GD than those without SLE, providing supportive evidence for SLE as a causative factor for GD.…”

Graves’ disease and the risk of immune-mediated diseases: Mendelian randomization and colocalization analyses in East Asian population.

“…The MR analysis indicated that patients with GD exhibit a 14% higher risk of developing RA, whereas those with RA have a 26% increased likelihood of developing GD. A cohort study of 8779 GD cases and 8779 controls in Taiwan showed that GD patients suffer an increased risk of SLE (hazard ratio [HR]: 5.45, 95%CI: 1.74-17.0) [32]. Based on our research, patients with GD have a higher chance of developing SLE as shown by a signi cant OR value of 1.31.…”

A 30-Year-Old Woman with a History of Autoimmune Hyperthyroidism Presenting with Fever and Oral Ulcers, Diagnosed with Discoid Lupus Erythematosus

“…On the other hand, research shows that GD is associated with a higher positive rate of incident SLE. Hyperthyroidism accelerates the basal metabolism and increases oxygen consumption and the production of reactive oxygen radicals, increasing oxidative stress leads to tissue peroxidation in the antioxidant defense system, and the immunological responses correlate with the disease activity and organ damage of SLE [15][16][17]. The role of cytokines and chemokines may be responsible for the inflammatory organdamaging response [18].…”